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Impact of DSM-5 PTSD and gender on impaired eating behaviors in 512 Italian earthquake survivors
... The presence of PTSD has also been recently associated with impaired eating behaviors, such as night eating, food addiction, binge eating, maladaptive eating as a coping strategy, weight change, and overweight/obesity over time, up to the onset of fullblown eating disorders (23)(24)(25). Moreover, in samples exposed to a traumatic event, significantly higher rates of eating disorders in women than in men were described (26)(27)(28). ...
... The MOODS-SR is a 140-item questionnaire exploring mood spectrum symptoms, coded dichotomously, as present or absent, for one or more periods of at least 3-5 days. According to previous researches and to the aims of the present study (11,26,43), we adopted a modified version of the instrument assessing symptoms developed in the aftermath of earthquake. Items are organized into three manic and three depressive domains, exploring "mood, " "energy, " and "cognition, " besides a rhythmicity and vegetative functions domain. ...
... Items are organized into three manic and three depressive domains, exploring "mood, " "energy, " and "cognition, " besides a rhythmicity and vegetative functions domain. This latter explores alterations in the circadian rhythms and vegetative functions, including changes in energy; physical well-being; mental and physical efficiency related to the weather and season; and changes in appetite, sleep, and sexual activities across 29 items (26,43). ...
Background: Increasing evidence indicates that survivors to traumatic events may show disruption of sleep pattern, eating and sexual behaviors, and somatic symptoms suggestive of alterations of biorhythmicity and vegetative functions. Therefore, the aim of this study was to investigate these possible alterations in a sample of survivors in the aftermath of earthquake exposure, with particular attention to gender differences and impact of post-traumatic stress disorder (PTSD). Methods: High school senior students, who had been exposed to the 2009 L'Aquila earthquake, were enrolled 21 months after the traumatic event and evaluated by the Trauma and Loss Spectrum Self-Report to investigate PTSD rates and by a domain of the Mood Spectrum Self-Report-Lifetime Version (MOODS-SR), to explore alterations in circadian/seasonal rhythms and vegetative functions. Results: The rates of endorsement of MOODS-SR rhythmicity and vegetative functions domain and subdomain scores were significantly higher in survivors with PTSD with respect to those without it. Among all earthquake survivors, women reported higher scores than men on the rhythmicity and vegetative functions domain and subdomain scores, except for the rhythmicity and sexual functions ones. Female survivors without PTSD showed significantly higher scores than men in the rhythmicity and vegetative functions total scores and the sleep and weight and appetite subdomains. Potentially traumatic events burden predicted rhythmicity and vegetative functions impairment, with a moderation effect of re-experiencing symptoms. Conclusions: We report impairments in rhythmicity, sleep, eating, and sexual and somatic health in survivors to a massive earthquake, particularly among subjects with PTSD and higher re-experiencing symptoms, with specific gender-related differences. Evaluating symptoms of impaired rhythmicity and vegetative functions seems essential for a more accurate assessment and clinical management of survivors to a mass trauma.
... Crises such as economic recession and climate change can also lead to a shift away from traditional diets towards diets made up of much more processed food with higher salt, sugar and fat contents (Bonaccio et al., 2014;Costarelli et al., 2013;Cunsolo Willox et al., 2012). Two articles in this literature review did not specify the specific kinds of foods eaten but did note an increased consumption of unhealthy food after the crisis event (Carmassi et al., 2015;Friel et al., 2014). Increased consumption of unhealthy food was also linked with increased time watching television and reduced physical activity (G ornicka et al., 2020;Sidor and Rzymski, 2020). ...
... The articles looked at how dietary patterns change and what the drivers of these changes were.3.5.1 Crisis events have a multi-directional effect on dietary patterns. Dietary pattern changes is discussed in 31 articles: 15 focused on COVID-19(Adams et al., 2020; Ammar et al., 2020;Ben Hassen et al., 2020; Carroll et al., 2020;Castellini et al., 2020;Di Renzo et al., 2020;G ornicka et al., 2020;Laguna et al., 2020;Papandreou et al., 2020;Pellegrini et al., 2020;Phillipou et al., 2020;Romeo-Arroyo et al., 2020;Ruiz-Roso et al., 2020;Scarmozzino and Visioli, 2020;Sidor and Rzymski, 2020), 8 focused on natural disasters(Carmassi et al., 2015;Cunsolo Willox et al., 2012;Forbes, 2017;Friel et al., 2014;Kuijer and Boyce, 2012;Larrance et al., 2007;Ma et al., 2020;Turner-McGrievy et al., 2020), 7 focused on economic recession(Alves and Perelman, 2019;Bonaccio et al., 2014;Bruening et al., 2012;Carney, 2012;Costarelli et al., 2013;Dore et al., 2003;Dowler and Lambie-Mumford, 2015) and 1 focussed on terrorism ...
Purpose
This literature scoping review aims to investigate if, how and why eating behaviours change after a crisis event such as a natural disaster, financial crisis or pandemic in high-income countries.
Design/methodology/approach
The COVID-19 pandemic and resulting “lockdowns” and social distancing measures have changed access to food, the types of food consumed and usual eating behaviours. Early research on the effect of the COVID-19 pandemic is compared with existing literature on other high-impact crises in high-income countries around the world, such as Hurricane Katrina and the Global Financial Crisis. A search of four electronic databases in August 2020 of literature from 2000 to 2020 yielded 50 relevant publications that were included in the qualitative thematic analysis.
Findings
The analysis found that crisis events made accessing food more difficult and led to increased food insecurity. Home cooking, sharing food and eating together (within households during the pandemic) all increased during and after a crisis. Resources often reduced and needed to be pooled. Crises had a multi-directional impact on dietary patterns, and the motivators for dietary pattern change differ between populations and crises.
Originality/value
In conclusion, eating behaviours impacted by crises because of the disruption of food systems, increased food insecurity and changes in daily routines. Community networks were a strong protective factor against adverse outcomes from food insecurity.
... Moreover, a large number of statistical comparisons may have led to type I errors; however, the use of multiparametric statistical models may mitigate this concern. Indeed, although we have observed a consistent effect of gender in all regression models, indicating that trauma reactions may be worse in females than in males, consistently with previous studies (Carmassi et al. 2015;Dell'osso et al. 2013); nevertheless, sleep and circadian variables reached significant effects on PTSS independently of gender. Finally, another limitation of our study is that we did not adjust our analyzes for mood disturbances, which could interact with the stress response and worsen PTSS Dell'Osso et al. 2014). ...
The present study aimed at evaluating how post-traumatic stress symptoms (PTSS) are associated with rest-activity circadian and sleep-related parameters, assessed both subjectively (via questionnaires) and objectively (via actigraphy). Specifically, we explored whether chronotype could moderate the association between sleep/circadian parameters and PTSS. Participants (n = 120 adults; mean age 35.6 ± 14; 48 male) were assessed through the Trauma and Loss Spectrum Self Report (TALS-SR) for lifetime PTSS, the reduced version of the Morningness-Eveningness Questionnaire (rMEQ) for chronotype, the Pittsburgh Sleep Quality Index (PSQI) for self-reported sleep quality, and wrist actigraphy for sleep and circadian parameters. Eveningness, poor self-reported sleep quality, lower sleep efficiency (SE), lower interdaily stability (IS), and higher intra-daily variability (IV) were correlated with higher TALS-SR scores. Regression analyses showed that IV, SE, and PSQI remained associated with TALS symptomatic domains after adjusting for potentially confounding factors (age and gender). Moderation analysis showed that only the PSQI remained significantly associated with TALS symptomatic domains; however, the interaction with chronotype was not significant. Targeting self-reported sleep disturbances and rest-activity rhythms fragmentation could mitigate PTSS. Although the effect of chronotype as a moderator of the associations between sleep/circadian parameters and PTSS was not significant, eveningness was associated with higher TALS scores, thus confirming the vulnerability of evening types to worse stress reactions. ARTICLE HISTORY
... The earthquake not only results in fatalities, injuries, destruction of buildings, and loss of livelihoods and materials but also severe and maybe permanent psychological consequences on the people living through the trauma. Common psychiatric problems following a disaster include acute stress reactions, post-traumatic stress disorder (PTSD), anxiety disorder, depression, panic disorders, and phobias in children and adolescents (7)(8)(9)(10). ...
The earthquake has long-lasting various mental and behavioral effects on children and adolescents. The aim of this review was to discuss the nature and extent of psychiatric problems, management options, and the process of organizing psychological interventions for affected children. Individuals show a range of physically, emotionally, and cognitively healthy responses that can help them cope with the aftermath of a disaster. Psychiatric symptoms such as acute stress reactions, post-traumatic stress disorder, depression, anxiety disorder, increased risk of suicide, sleep disorders, substance use disorders, and psychotic disorders may develop in some children. Comorbidities and sub-clinical syndromes are also common. There are many risk factors and protective factors in the development of mental disorders. Close follow-up of children at high risk and interventions for psychosocial support may prevent the development of mental disorders. It is very important to start the intervention at the earliest period. The psychological impacts of young disaster victims can be addressed by skilled local volunteers, medical professionals, and educators in primary health care programs. With the nation's overall social and economic recovery, children can recover more quickly from traumatic experiences.
... Considering the clinical setting, until recently the classical and historical medical approach was mainly focused on highlighting the pathological consequence of traumatic experiences, underlining the necessity of prevention strategies and of an early detection of the possible pathological trajectories. However, this conceptualization has often led to forget the other possible outcome, the positive one, even though deeply interlaced with the traumatic ad pathological course (Dell'Osso et al., 2014;Stratta et al., 2015;Carmassi et al. 2015;Dell'Osso et al., 2019;2021c). In the last years a growing number of studies have focused on the PTG, evaluating the possibility that life events may promote the loss of an older identity as well as the acquisition of a more functional one, endowed with greater adjustment and flexibility skills and more ultimately profitable. ...
The psychopathological consequences of traumatic experiences have been object of study from the beginning of medical science. During the last centuries, the scientific literature in the field of mental health mainly focused on the negative consequences of traumatic events. More recently, increasing interest was paid to the features of resilience and to the possible positive consequences of trauma, leading to the concept of Post Traumatic Growth (PTG). However, the eventual co-existence of both the conditions should also be considered. The role of vulnerability and environmental factors in the balance between positive and negative outcomes after life events is discussed, particularly in light of a neurodevelopmental approach to psychopathology.
... However, there is expanding literature reporting that exposure to traumatic events may increase the risk for multiple psychiatric disorders and the comorbidity between post-traumatic stress, depressive, and anxiety symptoms in this framework is well acknowledged [22][23][24][25][26][27]. Furthermore, the co-occurrence of these conditions can be related to underlying processes [28], and it is usually related to more severe psychopathological symptoms [28,29]. ...
During the 2020 first wave of the COVID-19 pandemic, general practitioners (GPs) represented the first line of primary care and were highly exposed to the pandemic risks, with a consequent risk of developing a wide range of mental health symptoms. However, scant data are still available on factors associated with a worse outcome. The aim of the present study was to investigate mental health symptoms in 139 GPs in the aftermath of the first COVID-19 national lockdown in Italy, detecting groups of subjects with different depressive, anxiety, and post-traumatic stress symptom severity. The impact of the mental health symptoms on quality of life and individual functioning were also evaluated. A cluster analysis identified three groups with mild (44.6%), moderate (35.3%), and severe psychopathological burden (20.1%). Higher symptom severity was related to younger age, fewer years in service as GPs, working in a high incidence area for the pandemic, having a relative at risk of medical complications due to COVID-19, besides more severe global functioning impairment, burnout, and secondary traumatic stress. The present findings showed that GPs, forced to perform their professional activity in extremely stressful conditions during the COVID-19 pandemic, were at high risk of developing mental health problems and a worse quality of life.
... This has been well demonstrated in an arthropod system where spiders change diet selection of prey by changing its physiological demands for carbohydrates (Barton, 2010;Beckerman et al., 1997;McMahon et al., 2018;Rothley et al., 1997;Schmitz, 1998). Interestingly, similar results have been reported in vertebrate taxa (Carmassi et al., 2015;Clinchy et al., 2013;Klingaman et al., 2016;Leaver & Daly, 2003), but examples from ungulates have not been reported. Although demonstrating predation risk inducing physiological changes that manifest in health and behavior is inherently difficult, this new frontier of merging nutritional ecology with predation risk theory has the potential to advance our understanding of the ecology of fear. ...
Because ungulates are important contributors to ecosystem function, understanding the "ecology of fear" could be important to the conservation of ecosystems. Although studying ungulate ecology of fear is common, knowledge from ungulate systems is highly contested among ecologists. Here, we review the available literature on the ecology of fear in ungulates to generalize our current knowledge and how we can leverage it for conservation. Four general focus areas emerged from the 275 papers included in our literature search (and some papers were included in multiple categories): behavioral responses to predation risk (79%), physiological responses to predation risk (15%), trophic cascades resulting from ungulate responses to predation risk (20%), and manipulation of predation risk (1%). Of papers focused on behavior, 75% were about movement and habitat selection. Studies were biased toward North America (53%), tended to be focused on elk (Cervus canadensis; 29%), and were dominated by gray wolves (40%) or humans (39%) as predators of interest. Emerging literature suggests that we can utilize predation risk for conservation with top-down (i.e., increasing predation risk) and bottom-up (i.e., manipulating landscape characteristics to increase risk or risk perception) approaches. It is less clear whether fear-related changes in physiology have population-level fitness consequences or cascading effects, which could be fruitful avenues for future research. Conflicting evidence of trait-mediated trophic cascades might be improved with better replication across systems and accounting for confounding effects of ungulate density. Improving our understanding of mechanisms modulating the nature of trophic cascades likely is most important to ensure desirable conservation outcomes. We recommend future work embrace the complexity of natural systems by attempting to link together the focal areas of study identified herein.
... In principle, this insight should provide a potential path for the development of pharmacotherapies to treat patients for whom traumatic memories disrupt eating, as in PTSD or anorexia (Carmassi et al., 2015;Mitchell et al., 2012). CeA CB1Rs are the obvious target for this kind of approach. ...
The circuit mechanisms underlying fear-induced suppression of feeding are poorly understood. To help fill this gap, mice were fear conditioned, and the resulting changes in synaptic connectivity among the locus coeruleus (LC), the parabrachial nucleus (PBN), and the central nucleus of amygdala (CeA)—all of which are implicated in fear and feeding—were studied. LC neurons co-released noradrenaline and glutamate to excite PBN neurons and suppress feeding. LC neurons also suppressed inhibitory input to PBN neurons by inducing heterosynaptic, endocannabinoid-dependent, long-term depression of CeA synapses. Blocking or knocking down endocannabinoid receptors in CeA neurons prevented fear-induced depression of CeA synaptic transmission and fear-induced suppression of feeding. Altogether, these studies demonstrate that LC neurons play a pivotal role in modulating the circuitry that underlies fear-induced suppression of feeding, pointing to new ways of alleviating stress-induced eating disorders.
... Increasing research is however warranted as a promising research path suicide and non-suicidal self-injuring focuses on the mediating role of dissociative symptoms 49 , whose clinical relevance has been recognized by DSM-5, through the introduction of the dissociative subtype 50 . The combined use of TALS-SR and MOODS-SR has also allowed us to examine the impact of Post-traumatic spectrum symptoms on altered eating behaviours, suggesting a wide range of abnormal eating habits among PTSD sufferers, as well as the existence of a strong link between PTSD and somatic symptoms burden 51,52 . On the other hand, exploring TALS-SR scores in patients suffering from fibromyalgia 15 , a statistically significant correlation between lifetime exposure to potentially traumatic events, in particular loss events, post-traumatic stress symptoms and severity of fibromyalgia, was detected. ...
Objectives:
The purpose of this article is to provide an overview of the studies conducted using the Trauma and Loss Spectrum-Self Report (TALS-SR) since its validation, also summarizing the
structure of this psychometric instrument and the underlying dimensional approach.
Methods:
In this article we revise the results obtained across several studies in which the TALS-SR
has been used. The Trauma and Loss Spectrum (TALS), also known as post-traumatic stress spectrum, was developed in the framework of the Spectrum Project, an Italy-USA research collaboration project aimed at developing and validating tools designed to assess the spectrum of clinical manifestations related to DSM mental disorders. It represents a multidimensional approach to Post-Traumatic Stress Disorder and includes: potentially traumatic and/or loss events to which one can be exposed across his/her lifetime; a spectrum of acute peri-traumatic reactions; a broad range of post-traumatic stress and/or Complicated Grief (CG) spectrum symptoms. Both a clinical interview and self-report instrument were developed, namely the: Structured Clinical Interview for Trauma and Loss Spectrum (SCI-TALS), and Trauma and Loss Spectrum-Self Report (TALS-SR). Both instruments consist of 116 items, coded dichotomously (yes/no) and grouped in 9 domains. Two out of nine domains explore symptoms related to the pathologic grief reactions related to the loss of a loved one, also named as CG or Persistent Complex Bereavement Disorder (PCBD), this latter to date first included in the DSM-5, in the Section III of disorders that deserve further clinical attention.
Results:
The instruments were validated and adopted in clinical samples, such as patients with PTSD, CG, affected by medical conditions (such as fibromyalgia), caregivers of children with chronic illnesses, Emergency Unit personell, as well as in general population samples (e.g. survivors to the April 2009 L’Aquila earthquake) and healthy controls. Studies comparing full
and partial symptomatological PTSD, in accordance to either the DSM-IV or DSM-5 criteria,
were also possible, due to the wide spectrum of trauma related sympotms encompassed by
the TALS, including the DSM-5 ones. Furthermore, the relationships between post-traumatic
stress spectrum and other psychopathological dimensions, such as mood, eating and adult
subthreshold autism spectrum, were explored.
Conclusions:
The use of the TALS-SR allows a valid exploration of the trauma and loss spectrum, in itself
and in relation to other psychopathological dimensions. Moreover, it represents a valuable
tool in clinical practice, for the diagnosis and management of PTSD.
... F-FDG rat brain image in coronal (left), sagittal (mid), and transverse (right) views of all three groups and microMRI rat template in coronal (bottomleft), sagittal (bottom-mid), and transverse (bottom-right) views. The amygdala, outlined in purple, was defined using a rat ROI-template based on Paxinos coordinates 2014; van den Berk-Clark et al. 2018) and some suggest that overeating is an emotionally driven response (Carmassi et al. 2015). ...
Imaging studies have shown abnormal amygdala function in patients with posttraumatic stress disorder (PTSD). In addition, alterations in synaptic plasticity have been associated with psychiatric disorders and previous reports have indicated alterations in the amygdala morphology, especially in basolateral (BLA) neurons, are associated with stress-related disorders. Since, some individuals exposed to a traumatic event develop PTSD, the goals of this study were to evaluate the early effects of PTSD on amygdala glucose metabolism and analyze the possible BLA dendritic spine plasticity in animals with different levels of behavioral response. We employed the inescapable footshock protocol as an experimental model of PTSD and the animals were classified according to the duration of their freezing behavior into distinct groups: “extreme behavioral response” (EBR) and “minimal behavioral response”. We evaluated the amygdala glucose metabolism at baseline (before the stress protocol) and immediately after the situational reminder using the microPET and the radiopharmaceutical ¹⁸F-FDG. The BLA dendritic spines were analyzed according to their number, density, shape and morphometric parameters. Our results show the EBR animals exhibited longer freezing behavior and increased proximal dendritic spines density in the BLA neurons. Neither the amygdaloid glucose metabolism, the types of dendritic spines nor their morphometric parameters showed statistically significant differences. The extreme behavior response induced by this PTSD protocol produces an early increase in BLA spine density, which is unassociated with either additional changes in the shape of spines or metabolic changes in the whole amygdala of Wistar rats.
... Eating disorders are connected to both autistic trait and PTSD: higher autistic traits are correlated to augmented prevalence of eating disorder [54]; alterations in eating behaviors are also frequently reported in patients with traumatic experiences [55], and there is a strong association between BED and PTSD [56,57]. ...
This case report highlights the relevance of the consequences of trauma in a female patient with an undetected autism spectrum disorder (ASD) affected by bipolar disorder (BD) with multiple comorbidities. A 35-year-old woman with BD type II, binge eating disorder and panic disorder was admitted in the Inpatient Unit of the Psychiatric Clinic of the University of Pisa because of a recrudescence of depressive symptomatology, associated with increase of anxiety, noticeable ruminations, significant alteration in neurovegetative pattern, and serious suicide ideation. During the hospitalization, a diagnosis of ASD emerged besides a history of childhood trauma and affective dysregulation, marked impulsivity, feeling of emptiness, and self-harm behavior. The patient was assessed by the Autism-Spectrum Quotient (AQ), Ritvo Autism and Asperger Diagnostic Scale (RAADS-R), the Adult Autism Subthreshold Spectrum (AdAS Spectrum), Trauma and Loss Spectrum (TALS-SR), and Ruminative Response Scale (RRS). Total scores of 38/50 in the AQ, 146/240 in the RAADS-R, 99/160 in the AdAS Spectrum emerged, compatible with ASD, 47/116 in the TALS-SR, and 64/88 in the RRS. We discuss the implications of the trauma she underwent during her childhood, in the sense that caused a complex posttraumatic disorder, a lifelong disease favored and boosted by the rumination tendency of high functioning ASD.
... Studies support the connection between PTSD and ED. Different kinds of traumatic events have been reported to be associated with ED: childhood sexual abuse (De Groot & Rodin, 1999;Wonderlich et al., 2001), sexual assault (Faravelli, Giugni, Salvatori, & Ricca, 2004;Tagay et al., 2010), physical and emotional abuse (Kent, Waller, & Dagnan, 1999;Rorty, Yager, & Rossotto, 1994), parental break-up or loss of a family member (Dalle Grave et al., 1996;Mahon, Bradeley, Harvey, Winston, & Palmer, 2001), earthquake (Carmassi et al., 2015), and war exposure without migration (Aoun et al., 2013). A study done by Vierling et al. (2015) on 130 participants with different types of ED in order to examine the association with PTSD showed that almost 34% of patients with ED suffered from PTSD. ...
The objective of this cross‐sectional study was to examine the prevalence and correlates of a positive screen for eating disorders (EDs) in a sample of Syrian refugees living in North Lebanon. The study was conducted on a convenience sample of 450 (84.67% women and 15.33% men) refugees, aged between 18 and 45 years. The prevalence of a positive screen for ED was 5.79%. Bivariate analyses revealed that female gender (p = 0.02), presence of medical conditions (p = 0.01), old occurrence of major stressful life event (p < 0.01), and positive primary care post‐traumatic stress disorder screen (p < 0.01) were associated with the positive sick, control, one stone, fat, food tool. Multiple logistic regression analyses showed that subjects screened with post‐traumatic stress disorder had a three times higher risk of having a positive screen for ED (odds ratio = 3.2; 95% confidence interval [1.32, 7.78]). Early detection of ED and related factors may help identify refugees who would benefit from interventions to improve mental health.
... The aim of the present study is thus to investigate the relationship between autistic traits and mood symptoms in a university student population, with a special focus on how autistic traits interact with rumination and trauma/stressor-related symptomatology in predicting mood symptoms. Based on previous research (Carmassi et al., 2015;Dell'Osso et al., 2012;Takara and Kondo, 2014b;Roberts et al., 2015;Stratta et al., 2016), we hypothesize (1) that a strong link will exist between autistic traits and mood symptoms, and (2) that trauma and stressor-related symptoms will be a mediating factor between autistic traits and mood symptoms. ...
An increasing number of studies highlighted significant correlations between autistic traits (AT) and mood spectrum symptoms. Moreover, recent data showed that individuals with high AT are likely to develop trauma and stressor-related disorders. This study aims to investigate the relationship between AT and mood symptoms among university students, focusing in particular on how AT interact with ruminations and trauma-related symptomatology in predicting mood symptoms. 178 students from three Italian Universities of excellence were assessed with The Structured Clinical Interview for DSM-5 (SCID-5), the Adult Autism Subthreshold Spectrum (AdAS Spectrum), the Ruminative Response Scale (RRS), the Trauma and Loss Spectrum (TALS) and the Moods Spectrum (MOODS). Considering the AdAS Spectrum total scores, 133 subjects (74.7%) were categorized as “low scorers” and 45 subjects (25.3%) as “high scorers”. Students in the high scorer group showed significantly higher scores on RRS, TALS-SR and MOOD-SR total scores. Total and direct effects of AdAS Spectrum total score on MOODS-SR total score were both statistically significant. AdAS Spectrum total score also showed a significant indirect effect on MOODS-SR total score through TALS and RRS total scores. Results showed a significant relationship between AT and mood spectrum, which is partially mediated by ruminations and trauma/stressor-related symptomatology.
... The study included 352 Syrian refugees settled in camps in Turkey. An experienced psychiatrist evaluated the participants, and results demonstrated that 33.5% of study participants had PTSD, mainly female refugees, people who experienced 2 or more SLE, or those who had a family history of psychiatric disorder20 .PTSD has been associated with a wide range of traumatic events: emotional or physical abuse 21 , sexual abuse 22 , parental break-up 23 , death of a loved one 24 , domestic violence 25 , kidnapping26 , military services 27 , war trauma 28 , natural disasters29 and medical conditions including cancer30 , heart attack 31 , stroke 32 , intensive-care unit hospitalization33 , and miscarriage34 . ...
Aims: The Syrian conflict has generated a large flow of refugees, more than one million of them located in Lebanon. Very few studies were
conducted on mental health of Syrian refugees. The objective of this study was to examine post-traumatic stress disorder (PTSD)
symptoms and to determine the associated risk factors in a sample of Syrian refugees living in North Lebanon.
Methods: An observational cross-sectional study was conducted, during February and March 2016, on a random sample of 450 (84.67%
women and 15.33% men) Syrian refugees, aged between 14 and 45 years, living in North Lebanon. Each participant was interviewed
individually using the Primary Care-PTSD (PC-PTSD) screening tool, translated into Arabic, with a back-translation to the original
language to verify its accuracy. Reporting three or more PTSD symptoms was defined as a positive screen. Descriptive statistics and
multiple regression analyses were used to examine the prevalence of a positive PTSD screen and associations with socio-demographic and
health-related characteristics.
Results: The prevalence of positive PTSD screen in our sample of Syrian refugees was 47.3%. There were statistically significant
associations between a positive PTSD screen and being a woman (P=0.011), married (P<0.001), older than 18 years (P=0.006), having
chronic medical conditions (P<0.001) and reporting more than 2 stressful life events (P<0.001).
Conclusion: The results of this survey are alarming, with high proportions of refugees at risk for PTSD. Early screening may help identify
individuals who would benefit from interventions to improve mental health.
... Due to the sample characteristics, the criterion A was considered satisfied. According to previous studies [21][22][23][24][25][26][27][28][29], symptomatological PTSD prevalence rates according to either the DSM-IV-TR and the DSM-5 criteria were assessed by means of a matching between the TALS-SR and the DSM PTSD symptoms. In particular, in the present study a symptomatological DSM-5 diagnosis of PTSD was assessed by using the following matching between DSM-5 symptoms criteria and TALS-SR items, a scheme already used in 2014 to assess gender differences in PTSD scores on a sample of 512 survivors to the L' Aquila earthquake [23]: ...
Background
Emergency services personnel face frequent exposure to potentially traumatic events, with the potential for chronic symptomatic distress. The DSM-5 recently recognized a particular risk for post-traumatic stress disorder (PTSD) among first responders (criterion A4) but data are still scarce on prevalence rates and correlates.
Objective
The aim of the present study was to explore the possible role of age, gender, and education training in a sample of emergency personnel diagnosed with DSM-5 PTSD.
Methods
The Trauma and Loss Spectrum-Self-Report (TALS-SR) and the Work and Social Adjustment Scale (WSAS) were administered to 42 between nurses and health care assistants, employed at the emergency room of a major University Hospital (Pisa) in Italy.
Results
21.4% of the sample reported DSM-5 PTSD with significantly higher scores in the TALS-SR domain exploring the acute reaction to trauma and losses among health care assistants, older, and non-graduated subjects. A significant correlation between the number of the TALS-SR symptoms endorsed, corresponding to DSM-5 PTSD diagnostic criteria emerged in health care assistants.
Conclusions
Despite further studies are needed in larger samples, our data suggest a high risk for PTSD and post-traumatic stress spectrum symptoms in nurses and health care workers operating in an emergency department, particularly among health care assistants, women, older, and non-graduated operators.
... Finally, Clinchy et al. (2013) suggest that chronic stress in humans may explain preference for carbohydrate-rich foods when suffering from post-traumatic stress disorder (Carmassi et al. 2015, Klingaman et al. 2016. Thus, there is compelling evidence that our results may apply to many other taxonomic groups. ...
Giving-up density (GUD) experiments have been a foundational method to evaluate perceived predation risk, but rely on the assumption that food preferences are absolute, so that areas with higher GUDs can be interpreted as having higher risk. However, nutritional preferences are context dependent and can change with risk. We used spiders and grasshoppers to test the hypothesis that covariance in nutritional preferences and risk may confound the interpretation of GUD experiments. We presented grasshoppers with carbohydrate-rich and protein-rich diets, in the presence and absence of spider predators. Predators reduced grasshopper preference for the protein-rich food, but increased their preference for the carbohydrate-rich food. We then measured GUDs with both food types under different levels of risk (spider density, 0 - 5). As expected, GUDs increased with spider density indicating increasing risk, but only when using protein-rich food. With carbohydrate-rich food, GUD was independent of predation risk. Our results demonstrate that predation risk and nutritional preferences covary and can confound interpretation of GUD experiments. This article is protected by copyright. All rights reserved.
... The AdAS Spectrum is a questionnaire developed by Dell'Osso et al. [55], within the framework of the international research network called Spectrum Project [47,48,[76][77][78][79][80][89][90][91]. The instrument was devised to assess the lifetime presence of the wide spectrum of manifestations associated with ASD, but which could be found even in individuals who do not fulfill diagnostic criteria for a formal disorder: in this regard, it was not developed to be a diagnostic instrument. ...
Aim:
Increasingly data suggest a possible overlap between psychopathological manifestations of eating disorders (EDs) and autism spectrum disorders (ASD). The aim of the present study was to assess the presence of subthreshold autism spectrum symptoms, by means of a recently validated instrument, in a sample of participants with EDs, particularly comparing participants with or without binge eating behaviours.
Methods:
138 participants meeting DSM-5 criteria for EDs and 160 healthy control participants (HCs), were recruited at 3 Italian University Departments of Psychiatry and assessed by the SCID-5, the Adult Autism Subthreshold Spectrum (AdAS Spectrum) and the Eating Disorders Inventory, version 2 (EDI-2). ED participants included: 46 with restrictive anorexia (AN-R); 24 with binge-purging type of Anorexia Nervosa (AN-BP); 34 with Bulimia Nervosa (BN) and 34 with Binge Eating Disorder (BED). The sample was split in two groups: participants with binge eating behaviours (BEB), in which were included participants with AN-BP, BN and BED, and participants with restrictive behaviours (AN-R).
Results:
participants with EDs showed significantly higher AdAS Spectrum total scores than HCs. Moreover, EDs participants showed significantly higher scores on all AdAS Spectrum domains with the exception of Non verbal communication and Hyper-Hypo reactivity to sensory input for AN-BP participants, and Childhood/Adolescence domain for AN-BP and BED participants. Participants with AN-R scored significantly higher than participants with BEB on the AdAS Spectrum total score, and on the Inflexibility and adherence to routine and Restricted interest/rumination AdAS Spectrum domain scores. Significant correlations emerged between the Interpersonal distrust EDI-2 sub-scale and the Non verbal communication and the Restricted interest and rumination AdAS Spectrum domains; as well as between the Social insecurity EDI-2 sub-scale and the Inflexibility and adherence to routine and Restricted interest and rumination domains in participants with EDs.
Conclusions:
Our data corroborate the presence of higher subthreshold autism spectrum symptoms among ED participants with respect to HCs, with particularly higher levels among restrictive participants. Relevant correlations between subthreshold autism spectrum symptoms and EDI-2 Subscale also emerged.
... In line with a spectrum approach, that in the last decades has been applied to most mental disorders, including FEDs [67][68][69][70][71][72][73], we could speculate that AN and ON share a common psychopathological process that is triggered by different factors, also depending on differential cultural pressures, and leading to clinical features that lie on a common spectrum [10]. From this perspective, ON could be a manifestation of restrictive, AN-like FEDs spectrum, elicited by the increasing attention devoted in modern society to healthy food. ...
Aims:
Orthorexia nervosa (ON) has been recently defined as a pathological approach to feeding related to healthiness concerns and purity of food and/or feeding habits. This condition recently showed an increasing prevalence particularly among young adults. In order to investigate the prevalence of ON and its relationship with gender and nutritional style among young adults, we explored a sample of students from the University of Pisa, Italy.
Methods:
Assessments included the ORTO-15 questionnaire and a socio-demographic and eating habits form. Subjects were dichotomized for eating habits (i.e. standard vs vegetarian/vegan diet), gender, parents' educational level, type of high school attended, BMI (low vs high vs normal BMI). Chi square tests were performed to compare rates of subjects with overthreshold ORTO-15 scores, and Student's unpaired t test to compare mean scores between groups. Two Classification tree analyses with CHAID growing method were employed to identify the variables best predicting ON and ORTO-15 total score.
Results:
more than one-third of the sample showed ON symptoms (ORTO-15 ≥ 35), with higher rates among females. Tree analyses showed diet type to predict ON and ORTO-15 total score more than gender.
Conclusions:
Our results seem to corroborate recent data highlighting similarities between ON and anorexia nervosa (AN). We propose an interpretation of ON as a phenotype of AN in the broader context of Feeding and eating disorders (FEDs) spectrum.
... Comparable to other mental disorders, the contributing role of modifiable lifestylerelated factors is becoming increasingly clear. For example, people with PTSD are more likely than the general population to smoke, with rates of 40-86% for clinical samples (Fu et al. 2007), be alcohol dependent (Blanco et al. 2013), and consume diets that are high in saturated fats and refined sugars (Carmassi et al. 2015), while low in fruit (Godfrey et al. 2013). Furthermore, PTSD symptoms and depression have also been shown to be associated with binge eating , further highlighting the importance of diet as a key modifiable risk factor. ...
... Comparable to other mental disorders, the contributing role of modifiable lifestylerelated factors is becoming increasingly clear. For example, people with PTSD are more likely than the general population to smoke, with rates of 40-86% for clinical samples (Fu et al. 2007), be alcohol dependent (Blanco et al. 2013), and consume diets that are high in saturated fats and refined sugars (Carmassi et al. 2015), while low in fruit (Godfrey et al. 2013). Furthermore, PTSD symptoms and depression have also been shown to be associated with binge eating , further highlighting the importance of diet as a key modifiable risk factor. ...
Posttraumatic Stress Disorder (PTSD) is a disorder associated with poor health outcomes including high rates of cardio-metabolic disease. Exercise and physical activity more broadly offer substantial promise as a feasible and effective component of care. Evidence to date demonstrates that exercise can improve both the physical and mental health of people with PTSD. Exercise should be included in the treatment of PTSD, across the spectrum from inpatients receiving treatment for severe PTSD, to trauma-exposed individuals living in the community with sub-syndromal symptomatology.
... There is agreement on the fact that PTSD affects females about twice as much as males, also in Italian samples, with more severe symptomatology. 26,33,[37][38][39][40][41] However, studies exploring the possible confounding role of other risk factors, including work-related training and education, reported conflicting results. 42,43 Some authors, in fact, highlighted that differences between the sexes may be compensated for by adequate professional training, as shown in rescue workers, police agents, or firefighters, particularly in the United States. ...
Introduction
PTSD is extremely common in patients with fibromyalgia (FM) with rates up to 57%, and it often correlates with increased severity of the disease.
Objectives
The aim of this study was to investigate the presence of PTSD, diagnosed according to DSM-5 criteria, and of Post-Traumatic Stress Spectrum symptoms in a sample of patients with FM.
Methods
Sixty-one patients, 7 males and 54 females, with FM, diagnosed according to American College of Rheumatology (ACR) at the Unit of Rheumatology of A.O.U.P clinics, were assessed by: SCID-5; Trauma and Loss Spectrum Self-Report (TALS-SR); Adult Autism Subthreshold Spectrum (AdAS Spectrum).
Results
Patients with FM with full and partial PTSD reported a significantly higher number of losses and potentially traumatic events in the TALS-SR than patients without PTSD. Significantly, higher AdAS Spectrum scores in almost all domains were reported in patients with PTSD with respect to those with partial or without PTSD. Moderate to good correlations were highlighted amongst most of the TALS-SR and ADAS-Spectrum domains.
Conclusions
Significant DSM-5 PTSD rates emerged in our sample of patients with FM. Significant correlations were found between Adult Subthreshold Autism Spectrum and Post-Traumatic Stress Spectrum, corroborating recent hypotheses that indicate autism spectrum symptoms as vulnerability factors for PTSD.
... Second, eating behaviors could, in fact, contribute to the phenomenon. Survivors of massive earthquakes could have impaired eating behaviors, 24 and clinically significant behavioral problems were found in one out of four young children living in the affected area of the Great East Japan Earthquake, 2 years after the disaster. 25 Transiently elevated BMI was also detected in Fukushima Prefecture (Fig. 3b). ...
Background:
The Great East Japan Earthquake followed by tsunamis and the Fukushima Daiichi Nuclear Power Plant (NPP) accident caused catastrophic damages. The effects of the disaster on the growth of affected children are of great concern but remain unknown.
Methods:
The study population was derived from two Japanese nationwide retrospective cohorts (historical and exposed groups, respectively). The exposed group experienced the disaster at 47 to 59 months of age. We analyzed longitudinal changes in the standard deviation scores (SDSs) for height and body mass index (BMI) using normal Japanese children's standards. Moreover, we analyzed the details of the affected children in Fukushima using Fukushima-specific growth charts established with the historical control data to clarify any indirect effect of the disaster on growth.
Results:
Affected children in Fukushima had significantly higher BMI SDSs than those of the historical control (difference: 0.13, 95% confidence interval (CI): 0.044-0.21, P = 0.0029) and regional controls (difference: 0.14, 95% CI: 0.074-0.20, P < 0.0001) 1.5 years after the disaster. Similar sustained increases in BMI SDSs were also found with Fukushima-specific growth charts, but the phenomenon was only detected in boys. Notably, the BMI SDSs of affected children who lived near the NPP had been increasing after the disaster, whereas those in distant areas had not changed. In contrast, height SDSs had not been changed throughout the analyses.
Conclusions:
Prolonged elevated BMI SDSs were only detected in affected children in Fukushima. This phenomenon may be explained by an indirect effect of the NPP accident. This article is protected by copyright. All rights reserved.
... Finally, Clinchy et al. (2013) suggest that chronic stress in humans may explain preference for carbohydrate-rich foods when suffering from post-traumatic stress disorder ( Carmassi et al. 2015, Klingaman et al. 2016). Thus, there is compelling evidence that our results may apply to many other taxonomic groups. ...
... 28 la prevalenza di fattori legati alla spiritualità personale, rispetto a una maggiore rilevanza di fattori di religiosità di comunità, sono altrettanto correlate all'incremento dell'ideazione suicidaria. 29,30 ogni evento disastroso è diverso dall'altro, con caratteristiche intrinseche che possono spiegare discrepanze tra i diversi studi. numerose osservazioni, comunque, concordano con quelle riportate in questa revisione. ...
Background:
an earthquake of 6.3 magnitude struck the town and province of L'Aquila on 6th April 2009. About 100,000 buildings were damaged, 1,600 people remained injured and 309 deceased; 66,000 people were left homeless by the disaster. The studies performed on the consequences of this seismic event have been numerous, more than those published on the occasion of similar events in Italy.
Design, setting and participants:
an electronic bibliographic research was conducted through Embase, MedLine, Current Contents, Web of Science, PsycINFO during a reference period from April 2009 to August 2015. All articles fulfilling keywords criteria of «L'Aquila» and/or «earthquake» were eventually selected. A further search was conducted on Google and Google Scholar and authors were contacted if necessary to obtain article copies. Finally, 56 papers were identified and grouped in areas of interest: studies in general population, clinical studies on psychiatric sample, studies on medical conditions, studies on suicidal behaviours, and studies human and animal behaviours.
Results:
Twenty-three studies were conducted on general populations, 9 of whom on adolescent samples. All studies were done in convenience samples. Thirteen clinical studies were conducted in psychiatric samples and 16 in medical or paraphysiological conditions. Three studies were conducted in suicidal ideations and behaviours. One article is about human and animal behaviours. These studies show that different population groups were characterized by specific kinds of response to the trauma with different possible interactions of risk and protective factors.
Conclusions:
from such observations it can be conceived that research on the evaluation and identification of the interventions have to change across years in order to meet the needs of the different subgroups of survivors.
... PTSD is characterized by a chronic stress reaction related to a traumatic event, including adverse childhood or adult experiences. Some research suggests that overeating serves to regulate emotions following a traumatic event [23]. In cases of PTSD related to physical or sexual abuse, excess weight may also be perceived as a protective factor for reducing vulnerability to subsequent abuse [24]. ...
Purpose of review:
The purposes of this study were to examine the relationships between obesity and a wide range of mental health issues and to identify where sex differences exist and may vary across disorders.
Recent findings:
Research on sex differences in the relationship between obesity and psychiatric disorders is more abundant in some areas, such as depression and eating disorders, than others, such as anxiety, trauma, and substance use. However, for most of the disorders, their relationships with obesity and sex are complex and are usually moderated by additional variables. Thus, studies that find stronger relationships for women between depression and obesity cross-sectionally do not tell the whole story, as longitudinal studies suggest that this relationship may also be present among men, particularly when confounders are considered. For those with eating disorders, men and women with obesity are fairly equally affected, and weight and shape concerns may play a role in maintaining these behaviors for both sexes. Weight stigma, though, seems to have worse consequences for women than men with obesity. Sex differences exist in relation to the associations between mental health and obesity. However, these differences vary by disorder, with disorder-specific moderators playing a role, such as age for depressive disorders, comorbid depression for anxiety disorders, and weight and shape concerns for eating disorders. More work is needed to understand if sex differences play a role in the relationship between obesity and anxiety, trauma, and substance use disorders.
... These include two studies on PTSD and emotional eating [24,25] (one showing a positive finding, the other null), two studies showing PTSD symptoms to be associated with food addiction [26,27], and four studies finding greater intake of unhealthy foods and/or lower intake of healthy foods among those with PTSD [28][29][30]. One study of earthquake survivors found that meeting PTSD diagnostic criteria was associated with increased craving for sweets or carbohydrates, as well as both increases and decreases in appetite [31]. Other common overeating behavior phenotypes have not been examined. ...
Background:
Posttraumatic stress disorder (PTSD) is a risk factor for obesity, but the range of behaviors that contribute to this association are not known.
Purpose:
The purpose of this study was to examine associations between self-reported PTSD symptoms in 2007, with and without comorbid depression symptoms, and three problematic overeating behaviors in 2010, and to estimate the associations of PTSD-related overeating behaviors with obesity.
Methods:
Cross-sectional and longitudinal analyses included 7438 male (n = 2478) and female (n = 4960) participants from the Growing Up Today Study (mean age 22-29 years in 2010). Three eating behavior outcomes were assessed: binge eating (eating a large amount of food in a short period of time with loss of control), top quartile of coping-motivated eating (from the Motivations to Eat scale), and top quartile of disinhibited eating (from the Three-Factor Eating Questionnaire).
Results:
PTSD symptoms were associated with two- to threefold increases in binge eating and top-quartile coping-motivated eating; having ≥4 PTSD symptoms, relative to no PTSD symptoms, was associated with covariate-adjusted RRs of 2.7 (95% CI 2.1, 3.4) for binge eating, 2.1 (95% CI 1.9, 2.4) for the top quartile of coping-motivated eating, and 1.5 (95% CI 1.3, 1.7) for the top quartile of disinhibited eating. There was a trend toward PTSD symptoms in 2007 predicting new onset binge eating in 2010. Having depression symptoms comorbid with PTSD symptoms further increased risk of binge eating and coping-motivated eating. All eating behaviors were associated with obesity.
Conclusion:
Clinicians treating patients with PTSD should know of potential comorbid problematic eating behaviors that may contribute to obesity.
... There is agreement on the fact that PTSD affects females about twice as much as males, also in Italian samples, with more severe symptomatology. 26,33,[37][38][39][40][41] However, studies exploring the possible confounding role of other risk factors, including work-related training and education, reported conflicting results. 42,43 Some authors, in fact, highlighted that differences between the sexes may be compensated for by adequate professional training, as shown in rescue workers, police agents, or firefighters, particularly in the United States. ...
Increasing literature suggests the need to explore for post-traumatic stress disorder (PTSD) and post-traumatic stress symptoms in parents and caregivers of children with acute and chronic illnesses but scant data are available on epilepsy. The aim of the present study was to estimate full and partial PTSD rates among parents of children with epilepsy comparing DSM-5 and DSM-IV-TR criteria. Further, the aim of the present study was to examine possible gender differences between mothers and fathers. Results showed 9.1% and 12.1% PTSD rates in the total sample, according to DSM-5 or DSM-IV-TR criteria, respectively, with an overall consistency of 92.9% (Kohen's K = 0.628, p = .453). Significant gender differences emerged for Avoidance/Numbing and Hyperarousal symptoms diagnosed by means of DSM-IV-TR criteria, as well as for Negative alterations in cognitions/mood and Hyperarousal symptoms, when adopting DSM-5 criteria. This study underscores the relevance of detecting PTSD in parents of children with a chronic illness such as epilepsy.
... Studies carried out among the survivors of similar earthquakes elsewhere in the world have demonstrated that children and adolescents present relatively high prevalence rates of the symptoms of PTSD, depression, anxiety, and other mental health problems in the wake of such disasters (cf. Armenia, Italy, Pakistan, Japan, and China) (Ben-Ezra et al., 2015;Carmassi et al., 2015;Goenjian et al., 2011;Hong & Efferth, 2015). These studies revealed that -especially after natural disastersbetween 10.23% and 74% of the survivors presented severe PTSD symptoms. ...
Working with street children and adolescents who lived through the 2010 earthquake in Port-au-Prince, this paper aims to assess the prevalence of symptoms of PTSD, anxiety and depression in relation to peritraumatic distress, and age, and to explore other risk factors and socio-demographic characteristics, four years after the events. Between March and June 2014, with a sample of 128 children and adolescents (120 boys and 8 girls) aged between 7 and 18, of an average age of 13.88 (SD=2.15), all living on the streets of Port-au-Prince, we used the following scales: the Trauma Exposure (TE), the Life Events Subscale of the CAPS; the Peritraumatic Distress Inventory (PDI); the Children's Revised Impact of Event Scale (CRIES-13) and the Children Depression Inventory (CDI); (BAI). Our study reveals a high prevalence of PTSD, depression and anxiety among street children. It also demonstrates that this prevalence is lower than that of several other groups of children who were also victims of the 2010 earthquake in Port-au-Prince. Children living in the streets for economic reasons presented a lower prevalence of symptoms of PTSD, anxiety and depression than those who were on the streets as a result of psychological or physical abuse within their own families, in adoptive families or in children's homes. This study demonstrates the importance of care provision for these children in terms of helping them develop coping and resilience strategies. It also stresses the importance of providing them with nonviolent living environments and opportunities to facilitate their return to normality.
... Earthquakes are one of the most frequent natural disasters throughout the world affecting numbers of people, often striking unexpectedly, threatening lives and leading to large scale destruction (Armenian et al., 2000;Bödvarsdottir and Elklit, 2004;Lai et al., 2004;Bland et al., 2005;Chang et al., 2005;Önder et al., 2006;Wang et al., 2009;Priebe et al., 2010;Ehring et al., 2011). Extensive research has been conducted on mental disorders following earthquakes as the mental distress associated with these experiences poses relevant challenges to mental health services (Armenian et al., 2002;Goenjian et al., 2005;Kun et al., 2009;Hussain et al., 2010), and most recently in Italy, particularly after the L'Aquila earthquake of 2009 (Dell'Osso et al., 2011b;Dell'Osso et al., 2011a;Dell'Osso et al 2013a;Carmassi et al., 2013;Carmassi et al 2014a;Carmassi et al., 2015). Italy is one of the most seismically active countries in Europe but it is unusual for the Country to experience deadly earthquakes, such as that Richter Magnitude 6.3 which stroke the town of L'Aquila on April 2009. ...
Important changes were introduced concerning posttraumatic-stress disorder (PTSD) by the DSM-5 recognizing the role of negative emotions such as guilt and shame, but little evidence is yet available on their prevalence in population assessed by means of DSM-5 criteria. In this study we explored the rates of guilt and shame DSM-5 PTSD diagnostic symptoms among Italian survivors to a massive earthquake and their possible correlation with PTSD and maladaptive behaviors. 869 residents of the town of L’Aquila exposed to the earthquake of April 6th 2009 were investigated by the Trauma and Loss Spectrum-Self Report (TALS-SR) with particular attention to guilt and shame feelings. DSM-5 symptomatological PTSD was reported by 41,7% of survivors, further 11,6% endorsed at least one guilt/shame symptoms, with significantly higher rates of endorsement were in PTSD respect to No-PTSD subjects, and in the subgroup with at least one maladaptive behavior respect to those with none. There was a significant main effects of PTSD and at least one guilt/shame symptom on TALS-SR symptomatological domains. Mean TALS-SR Maladaptive coping domain score appeared significantly higher in the subgroup with at least one guilt/shame symptom. Further study are needed to investigate guilt and shame feelings in survivors to a natural disaster.
... [7] Increased risk of cardio-metabolic diseases in PTSD is partly accounted for by a complex interplay of risk factors including genetic factors, [8] shared pathophysiological mechanisms [9,10] and cardio-metabolic side effects of psychotropic medications, [11] often used off-label in PTSD. [12] Modifiable lifestyle factors, including substance use, [13,14] unhealthy eating habits [15] and a sedentary lifestyle [16] are increasingly recognised as promising targets for intervention. ...
Purpose:
People with posttraumatic stress disorder (PTSD) have an increased risk of cardiovascular diseases (CVD). Physical fitness is a key modifiable risk factor for CVD and associated mortality. We reviewed the evidence-base regarding physical fitness in people with PTSD.
Methods:
Two independent reviewers searched PubMed, CINAHL, PsycARTICLES, PEDro, and SPORTDiscus from inception until May 2016 using the key words "fitness" OR "exercise" AND "posttraumatic stress disorder" OR "PTSD".
Results:
In total, 5 studies involving 192 (44 female) individuals with PTSD met the inclusion criteria. Lower baseline physical fitness are associated with greater reductions in avoidance and hyperarousal symptoms, as well as with total, physical, and social symptoms of anxiety sensitivity. Rigorous data comparing physical fitness with age- and gender matched general population controls are currently lacking.
Conclusions:
The research field regarding physical fitness in people with PTSD is still in its infancy. Given the established relationships between physical fitness, morbidity and mortality in the general population and the current gaps in the PTSD literature, targets for future research include exploring: (a) whether people with PTSD are at risk of low physical fitness and therefore in need of intensified assessment, treatment and follow-up, (b) the relationships among physical fitness, overall health status, chronic disease risk reduction, disability, and mortality in individuals PTSD, (c) psychometric properties of submaximal physical fitness tests in PTSD, (d) physical fitness changes following physical activity in PTSD, and (e) optimal methods of integrating physical activity programs within current treatment models for PTSD. Implications for Rehabilitation People with PTSD should aim to achieve 150 minutes of moderate or 75 minutes vigorous physical activity per week while also engaging in resistance training exercises at least twice a week. Health care professionals should assist people with PTSD to overcome barriers to physical activity such as physical pain, loss of energy, lack of interest and motivation, generalized fatigue and feelings of hyperarousal.
... 7 In addition, cumulative long-term effects of poor health behaviors place people with PTSD at greater risk of cardiometabolic diseases. 8 People with PTSD are more likely than the general population to have unhealthy lifestyle behaviors, including high rates of sedentary behavior, 9 smoking, 10 alcohol and substance abuse, 11 and unhealthy eating habits (ie, diets high in saturated fats and refined sugars 12 and low in fruit 13 ). In a recent review, Hall et al 14 found that the current literature regarding physical activity in people with PTSD is inconsistent, with more or less one-half of the identified studies reporting a significant negative association between PTSD and physical activity participation and the other one-half reporting no significant associations between PTSD and physical activity at all. ...
Background:
People with posttraumatic stress disorder (PTSD) are more likely than the general population to be physically inactive. The present review systematically evaluated correlates of physical activity across the socio-ecological model for people with PTSD.
Methods:
Two independent reviewers searched Embase, PubMed, PsycARTICLES and CINAHL from inception until June 2015, combining the medical subject heading 'post-traumatic stress disorder' or 'PTSD', with 'physical activity' or 'exercise'. Data were extracted by the same independent researchers and summarized according to the socio-ecological model.
Results:
Eight papers involving 1,368 (994♂) participants (age range=18-70years) were eligible and enabled evaluation of 21 correlates. The only correlate consistently (n≥4) associated with lower physical activity participation in persons with PTSD were symptoms of hyperarousal. No consistent facilitators were identified.
Conclusions:
Hyperarousal symptoms are associated with lower physical activity participation among people with PTSD and should be considered in the design and delivery of individualized exercise programs targeting this population. The role of social, environmental and policy factors on physical activity participation among people with PTSD is unknown and should be addressed by future research.
... There is agreement on the fact that PTSD affects females about twice as much as males, also in Italian samples, with more severe symptomatology. 26,33,[37][38][39][40][41] However, studies exploring the possible confounding role of other risk factors, including work-related training and education, reported conflicting results. 42,43 Some authors, in fact, highlighted that differences between the sexes may be compensated for by adequate professional training, as shown in rescue workers, police agents, or firefighters, particularly in the United States. ...
The Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) has recently recognized a particular risk for posttraumatic stress disorder (PTSD) among first responders (criterion A4), acknowledging emergency units as stressful places of employment. Little data is yet available on DSM-5 among emergency health operators. The aim of this study was to assess DSM-5 symptomatological PTSD and posttraumatic stress spectrum, as well as their impact on work and social functioning, in the emergency staff of a major university hospital in Italy. One hundred and ten subjects (doctors, nurses, and health-care assistants) were recruited at the Emergency Unit of the Azienda Ospedaliero-Universitaria Pisana (Italy) and assessed by the Trauma and Loss Spectrum-Self Report (TALS-SR) and Work and Social Adjustment Scale (WSAS). A 15.7% DSM-5 symptomatological PTSD prevalence rate was found. Nongraduated persons reported significantly higher TALS-SR Domain IV (reaction to loss or traumatic events) scores and a significantly higher proportion of individuals presenting at least one maladaptive behavior (TALS-SR Domain VII), with respect to graduate ones. Women reported significantly higher WSAS scores. Significant correlations emerged between PTSD symptoms and WSAS total scores among health-care assistants, nongraduates and women. Our results showed emergency workers to be at risk for posttraumatic stress spectrum and related work and social impairment, particularly among women and nongraduated subjects.
The potentially traumatic impact of the COVID-19 pandemic in subjects with pre-existing mental disorders is still unclear, especially regarding its long-term consequences. The aim of this study was to prospectively assess post-traumatic stress disorder (PTSD) and post-traumatic stress symptoms (PTSS) in patients with mental disorders, during the 3rd wave of the infection (T0, March-April 2021) while strict containment measures were applied in Italy, and after 3 months (T1, June-July 2021), with reduced restrictive measures. A total sample of 527 subjects, with different DSM-5 diagnoses, was consecutively enrolled at nine Italian psychiatric outpatient services. Assessments at T0 included: the Trauma and Loss Spectrum-Self Report (TALS-SR), the Impact of Event Scale-Revised (IES-R) and the Work and Social Adjustment Scale (WSAS). These two latter were repeated at T1. Results showed that at T0, 43.6% of the sample reported symptoms of PTSD, with females (p = .004), younger subjects (p = .011), unemployed/students (p = .011), and living with their parental families (p = .017), resulting more affected. Differences in PTSD rates emerged across diagnostic groups ranging from 10% in patients with psychoses up to 59% in those with feeding and eating disorders. An improvement at T1 emerged in all diagnostic groups for the IES-R scores, while WSAS scores improved only in subjects with mood disorders. In conclusions, subjects with mental disorders presented relevant rates of PTSD and PTSS at 1-year into the pandemic. Further long-term studies are needed to follow-up the course of pandemic traumatic burden especially in patients with severe mental disorders.
Factors such as regulations and health concerns shifted daily habits, including eating behaviors, during the early months of the COVID-19 pandemic. This comprehensive narrative review synthesizes research on eating behavior changes during the early months of the COVID-19 pandemic (February-June 2020) including changes in amount, rate and timing of food consumption, types and healthfulness of foods consumed, the occurrence of other specified eating behaviors (e.g., restrained eating, binging), and reasons for eating (e.g., stress, cravings), among adults. A literature search using three EBSCOhost databases and Google Scholar was conducted to identify relevant articles made available in 2020. A total of 71 articles representing 250,715 individuals from over 30 countries were reviewed. Findings show eating behaviors changed little during the early pandemic for most participants. Among those whose eating behaviors changed, increases in both intake and frequency of eating meals and snacks were more common than decreases. Findings on timing of eating and healthfulness of food consumed showed mixed results. However, when changes occurred in the type of food consumed, increases were more common for snacks, homemade pastries, white bread/pasta, legumes, and fruits/vegetables; decreases were more common for meats, seafood/fish, frozen foods, fast food, dark breads/grains, and dark leafy green vegetables. During the pandemic, binging, uncontrolled eating, and overeating increased, meal skipping decreased, and restrictive eating had mixed findings. Changes in factors such as emotions and mood (e.g., depression), cravings, and environmental factors (e.g., food insecurity) were related to changes in eating behaviors. Findings can inform clinical practitioners in efforts to mitigate disruptions to normal, healthy eating patterns among adults both in and outside of global health catastrophes.
Aims of the present study are to test the efficacy of a lifestyle group intervention, compared to a brief psychoeducational intervention, on levels of physical activity and dietary habits in a real-world sample of patients with severe mental disorders. The study, funded by the Italian Ministry of Education, has been carried out in six Italian University psychiatric outpatient units. All patients were randomly assigned to the experimental or control group and were assessed through standardized assessment instruments at baseline and six months after randomization. Of the 401 recruited patients, 43.3% had a diagnosis of bipolar disorder, 29.9% of psychosis and 26.9% of major depression. Patients were mainly female (57%), with a mean age of 45.6±11.8 years. Treated patients have almost 8 times the likelihood to show an increase of the total MET (OR: 8.02; p<.001) and of the walking MET (OR: 7.68; p<.001) and are more likely to increase the weekly consumption of vegetables (OR= 1.98, p<.05) and to reduce that of junk food (OR:0.23; p<.05). The present study support the notion that patients with severe mental disorders can improve their lifestyle behaviours and that, with appropriate support, they can achieve a healthy living.
In our country, activities are carried out under the title of zoning studies in order to make an
area suitable for holistic living standards. There is a hierarchy in the formation of zoning plans
from the upper scale of the country development plans to the lower scale, which are the
implementation zoning plans. With this hierarchy, in the 1/1000 zoning plans, residence + trade
islands are determined within the zoning boundaries determined to meet the housing and trade
needs of the people living in a region. Housing + commercial zoning blocks may have different
building regulations, precedent or building heights. There are possible building regulations
within the zoning boundaries, where there may be different types of sitting areas, such as split,
block and adjacent basis. The process of granting construction permits to the existing zoning
parcels in the zoning islands, whose identities are determined by these building regulations, is
the zoning scale. Zoning diameters, planned areas are given within the framework of type
zoning regulations and plan notes. The zoning diameter is given according to the precedent,
height and building order of the island. Distance method, on the other hand, is the process of
creating the right residential area with the drawing rules of convex shapes, such as square or
rectangular, according to the geometric condition of the parcel, in order to be able to give
construction permits to the clean zoning parcels in the relevant zoning islands. In our study, it
has been tried to show how the settlement areas on the floor can be given, which building order,
which precedent and how to apply the process to the convex parcels with the distance approach.
The association between eating disorders (EDs) and trauma represents a central object of study for clinical practice. Literature has dealt with the relationship between trauma and EDs for many years, and the term “post-traumatic eating disorder” has been introduced. This chapter illustrates the possible interactions between trauma and EDs, describing how these disorders generate a clinical and symptomatologic complexity. “Hidden” interactions need to be explored in order to reflect and discuss how to treat the presence of this comorbidity. The main factors involved in the theoretical clinical structuring of this association and the way in which these contents represent a contribution for future research will be presented. Understanding the functioning of these mechanisms can allow the clinicians to improve the treatment planning, in order to structure appropriate clinical management for patients suffering from these pathologies.
Objective:
The aim of this study is to determine the demographic and clinical characteristics associated with the need for long-term treatment in a child psychiatry facility.
Method:
Demographic characteristics, diagnosis, source of referral, time elapsed between the earthquake and the request for care, and the treatment prescribed in the baseline assessment were compared between a group of subjects that required long-term treatment (LTT) and a group that was discharged after a brief intervention (D).
Results:
A total of 171 patients were seen, and 27% of the subjects required LTT. In general, these subjects were younger, referred from highly affected areas, presented a delay in seeking care, and were mainly diagnosed with anxiety and stress-related disorders.
Conclusions:
These findings suggest the need for research regarding the design of mental health programs for the early detection of psychopathology after natural disasters in children and adolescents.
Background
PTSD and burnout are frequent conditions among emergency healthcare personnel because exposed to repeated traumatic working experiences. Increasing evidence suggests high comorbidity between PTSD and mood symptoms, particularly depression, although the real nature of this relationship still remains unclear. The purpose of this study was to investigate the relationship between PTSD, burnout and lifetime mood spectrum, assessed by a specific scale, among health-care professionals of a major University Hospital in Italy.
Methods
N=110 Emergency Unit workers of the Azienda Ospedaliero-Universitaria Pisana (Pisa, Italy) were assessed by the TALS-SR, MOODS-SR lifetime version and the ProQOL R-IV.
Results
Approximately 60% of participants met at least one PTSD symptom criterion (criterion B, 63.4%; criterion C, 40.2%; criterion D 29.3%; criterion E, 26.8%), according to DSM-5 diagnosis. Almost sixteen percent of the sample reported a full symptomatic DSM-5 PTSD (work-related) diagnosis, and these showed significantly higher scores in all MOODS-SR depressive domains, as well as in the rhythmicity domain, compared with workers without PTSD. Further, mood-depressive and cognition-depressive MOODS-SR domains resulted to be predictive for PTSD. Significant correlations emerged between either PTSD diagnosis and criteria or ProQOL subscales and all the MOOD-SR domains.
Conclusion
A significant association emerged among PTSD, burnout and lifetime MOOD Spectrum, particularly the depressive component, in emergency health care operators, suggesting this population should be considered at-risk and undergo regular screenings for depression and PTSD.
Background
Mental disorders are frequently related to sexual dysfunction (SD) but scant data are still available on trauma-related disorders, particularly post-traumatic stress disorder (PTSD).
Aim
To evaluate the relationships between SD and PTSD in 2009 L'Aquila (Italy) earthquake young adult survivors, with particular attention to gender differences.
Methods
Five hundred twelve high-school senior students were assessed 21 months after exposure by the following: Trauma and Loss Spectrum–Self-Report (TALS-SR), for post-traumatic spectrum symptoms; Mood Spectrum–Self-Report (MOODS-SR) lifetime version, for mood spectrum symptoms (including SD-related symptoms). Descriptive and inferential statistics were adopted.
Outcomes
TALS-SR and MOODS-SR scores were analyzed to evaluate PTSD- and SD-related symptoms.
Results
Around 6.5% of subjects reported SD-related symptoms with males showing higher rates than females in each symptom, with a statistically significant difference in item n = 154 (…less sexually active). Survivors with symptomatological PTSD reported rates up to 10%, with higher ratio of endorsing at least one SD-related symptom than with NO-PTSD. Significantly higher total MOODS-SR SD-related symptom scores emerged in survivors with symptomatological PTSD than in those with NO-PTSD, and a 2-way ANOVA showed a significant main effect of symptomatological PTSD and gender and gender × PTSD interaction.
Clinical Implications
SD-related symptoms are reported among young adult survivors to earthquake exposure and the number of symptoms is related to PTSD, particularly in males, suggesting the need for accurate evaluation.
Strengths & Limitations
Strengths are the large sample of young adult survivors to a massive natural disaster; the long-time frame from exposure corroborating the role of PTSD; the assessment of symptoms specifically occurring after exposure. Limitations are as follows: the lack of a specific scale for SD; the self-report instruments other than clinical interviews, that may be less accurate; the lack of information on the presence of somatic illness and other mental disorders; the lack of a control group; the young age of the sample because of the lifetime sexual experiences of the subjects, in addition to the lack of a comparison measure of sexual functioning before the earthquake.
Conclusions
Our results highlight relevant rates of SD-related symptoms in young adults exposed to the L'Aquila earthquake, particularly males and subjects with PTSD, suggesting SD may represent a specific male gender–related somatic complaint. Our results highlight the need for accurate investigation of SD in such population to improve clinical management and appropriate treatment.
Carmassi C, Dell'Oste V, Pedrinelli V, et al. Is Sexual Dysfunction in Young Adult Survivors to the L'Aquila Earthquake Related to Post-traumatic Stress Disorder? A Gender Perspective. J Sex Med 2020;XX:XXX–XXX.
Objectives Several studies have shown that survivors of natural disasters present high PTSD rates. On 6th April 2009, L'Aquila (Central Italy) was jolted by a 6.3 Richter scale magnitude earthquake causing a massive destruction of the town. More than 300 individuals died, 1,600 were injured and about 65,000 displaced. The aim of this paper is to review the researches conducted on survivors to this earthquake in the context of the Pisa-L'Aquila Collaboration Project which is going on since 2009, in order to assess post-traumatic stress spectrum psychopathology and its correlates. Methods An overall sample of more than 2000 earthquake survivors was assessed by means of the Trauma and Loss Spectrum-Self Report (TALS-SR), a questionnaire exploring post-traumatic stress spectrum symptoms. The TALS-SR offers a multidimensional approach that considers three major dimensions: potentially traumatic events, including losses and the so-called low magnitude events; symptoms of the acute/peri-traumatic reaction; post-traumatic spectrum symptoms. Survivors were also assessed by means of Mood Spectrum-Self Report (MOODS-SR), to detect correlations between post-traumatic stress spectrum and mood spectrum symptoms. Results High prevalence rates of both full and partial PTSD were found, as well as several factors (e.g. younger age, female gender, degree of exposure, bereavement experiences) associated with an increased likelihood of post-traumatic stress symptoms. Survivors with PTSD also reported significantly higher prevalence rates of specific symptoms, such as maladaptive behaviors including suicidality, and impairment in eating behaviors and somatic symptoms. Conclusions These studies highlighted the heavy burden of PTSD in the aftermath of the earthquake, even months after exposure, and a close relationship between post-traumatic stress spectrum and mood spectrum symptoms, suggesting the need of additional research.
Posttraumatic stress disorder (PTSD) and eating pathology are frequently comorbid, and both are independent risk factors for various medical conditions. Using population-based data collected as part of the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC-III; N = 36,309), the primary objectives of this study were to (a) identify eating pathology classes among PTSD and (b) investigate associations between maladaptive eating and medical conditions among PTSD. Using the Alcohol Use Disorder and Associated Disabilities Interview Schedule (AUDADIS-5), we assessed PTSD and maladaptive eating symptoms in accordance with the DSM-5. We used a latent class analysis to identify maladaptive eating typologies among adults with lifetime PTSD (n = 2,339; 6.1%) and multivariable logistic regression models to examine associations between each of the six emergent maladaptive eating typologies and medical conditions. Results revealed that over 40% of individuals with PTSD endorsed indicators of maladaptive eating. In addition, each maladaptive eating typology among PTSD was significantly associated with unique sociodemographic characteristics and increased odds of medical conditions relative to no PTSD and no eating disorder, adjusted odds ratios (AORs) = 1.34-6.55, and PTSD with no eating psychopathology, AORs = 1.43-5.11. Results of this study provide a better understanding of maladaptive eating in adults with PTSD and potential medical sequelae. Results indicate maladaptive eating may be an important mechanism in the association between PTSD and medical conditions, which may inform targeted interventions among individuals with these comorbidities.
The objective of this study was to investigate the relationship between serum lipid concentrations and PTSD symptoms in the bereaved after a traumatic familial loss. Eighteen months after the Sewol ferry disaster, 107 subjects who experienced traumatic losses as a result of the accident completed a mental and medical survey as well as laboratory tests for lipid profiles. At 30 months after the trauma, a total of 64 individuals completed a follow-up psychometric survey and biochemical measurements. We performed multiple linear regression analyses, examining the association between PTSD symptoms and lipid profiles. Other potential influences on lipid profiles such as metabolic risk factors, demographic risk factors, and underlying medical history were accounted for. Participants reporting clinically significant PTSD symptoms exhibited lower serum HDL-C levels than those without PTSD symptoms. In addition, we found that the severity of PTSD symptoms and sex could explain the changes in lipid profiles independently of other possible risk factors of changes. The results of this study suggest that PTSD symptoms may contribute to an increased risk for developing metabolic syndrome via detrimental changes in lipid concentrations. Routine screening and multidisciplinary management to prevent metabolic syndrome in individuals who experience traumatic losses would therefore be valuable.
A growing body of literature has explored Post-Traumatic Stress Disorder (PTSD) since its first introduction in DSM-III, up to the last DSM-5 edition that acknowledged the nosographic independence of post-traumatic stress conditions with respect to other mental disorders. In the past decades, increasing research has focused on the mental health impact of mass trauma such as earthquake on the general populations exposed, highlighting PTSD as being the most frequently occurring mental disorder affecting up to as much as even 80 % of the victims involved, particularly women. Women have been consistently demonstrated to be the most affected, as well as more symptomatic with respect to men, and with a substantially more chronic and disabling disorder. Interestingly, maladaptive behaviors that have been acknowledged by the DSM-5 among criterion symptoms, such as reckless driving, promiscuous sex, alcohol and drug addiction, self-injuring behaviors, and suicidal behaviors, show a different trend with men being the most affected, particularly in the younger age ranges. All these data support the need for specific interventions in the aftermath of such disasters, with particular attention to female gender.
A growing body of literature has explored Post-Traumatic Stress Disorder (PTSD) since its first introduction in DSM-III, up to the last DSM-5 edition that acknowledged the nosographic independence of post-traumatic stress conditions with respect to other mental disorders. In the past decades, increasing research has focused on the mental health impact of mass trauma, such as earthquakes, on the general populations exposed, highlighting PTSD as being the most frequently occurring mental disorder affecting up to as much as even 80 % of the victims involved, particularly women. Women have been consistently demonstrated to be the most affected, as well as more symptomatic with respect to men, and with a substantially more chronic and disabling disorder. Interestingly, maladaptive behaviors that have been acknowledged by the DSM-5 among criterion symptoms, such as reckless driving, promiscuous sex, alcohol and drug addiction, self-injuring behaviors, and suicidal behaviors, show a different trend with men being the most affected, particularly in the younger age ranges. All these data support the need for specific interventions in the aftermath of such disasters, with particular attention to female gender.
Among individuals exposed to the World Trade Center (WTC) disaster on September 11, 2001, posttraumatic stress disorder (PTSD) and symptoms are both common and associated with increased cigarette smoking and body mass. However, there is little information on the specific processes underlying the relationship of PTSD symptoms with body mass. The current study is an initial exploratory test of anxiety sensitivity, the fear of internal bodily sensations, as a possible mechanism linking PTSD symptom severity and body mass index (BMI). Participants were 147 adult daily smokers (34.0% female) exposed to the WTC disaster (via rescue/recovery work or direct witness). The direct and indirect associations between PTSD symptom severity and BMI via anxiety sensitivity (total score and subscales of physical, cognitive, and social concerns) were examined. PTSD symptom severity was related to BMI indirectly via anxiety sensitivity; this effect was specific to physical concerns about the meaning of bodily sensations. Interventions focusing on anxiety sensitivity reduction (specifically addressing physical concerns about bodily sensations) may be useful in addressing elevated BMI among trauma-exposed persons.
The aim was to investigate the prevalence of post traumatic stress disorder (PTSD) in people who had left their damaged homes and were still living in temporary housing more than a year after the April 2009 L'Aquila (Italy) earthquake. In addition, we evaluated the differences in coping strategies implemented by persons who had and who did not have PTSD. A cross-sectional prevalence study was carried out on a sample of 281 people aged >18 years and living in temporary housing after the earthquake. The questionnaires used include the Davidson Trauma Scale and the Brief Cope. The prevalence of PTSD was 43%. Women and the non-employed were more vulnerable to PTSD, while, age and level of education were not associated with PTSD. Those with PTSD symptoms often employed maladaptive coping strategies for dealing with earthquake and had the highest scores in the domains of denial, venting, behavioral disengagement, self-blame. By contrast, those without PTSD generally had more adaptive coping mechanisms. Adults who were living in temporary housing after the earthquake experienced high rates of PTSD. The difference in coping mechanisms between those who have PTSD and those who do not also suggests that they influence the likeliness of developing PTSD.
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The aim of the present study was to explore the correlations between Spirituality/Mysticism/Psychoticism symptoms and suicidality in young adult survivors of the L'Aquila earthquake. The sample included 475 subjects recruited among high school seniors who had experienced the April 6, 2009, earthquake. Assessments included: Trauma and Loss Spectrum-Self Report and Mood Spectrum-Self Report (MOODS-SR). Mysticism/Spirituality dimension and suicidality were evaluated by means of some specific items of the MOOD-SR. The Spirituality/Mysticism/Psychoticism MOODS-SR factor score was significantly higher among subjects with PTSD diagnosis with respect to those without. Similarly, subjects with suicidal ideation, as well as those who committed a suicide attempt, reported significantly higher scores than those without.
This study aimed to evaluate the association between chronic Post-Traumatic Stress Disorder (PTSD) and both structural and cognitive social capital in adult survivors of the 2007 earthquake in Pisco, Peru. Cognitive social capital measures trust, sense of belonging and interpersonal relationships in the community and structural social capital measures group membership, support from community groups and individuals, and involvement in citizenship activities. We conducted a population-based cross-sectional study in five counties in Pisco, selecting 1012 adults through complex, multi-stage random sampling. All participants completed socio-demographic questions and validated Spanish-language versions of the Adapted Social Capital Assessment Tool (SASCAT) and the civilian PTSD checklist (PCL-C). After performing descriptive and bivariate analyses, we carried out prevalence ratio (PR) regression. The overall prevalence of chronic PTSD was 15.9% (95% CI: 12.3, 19.8), much higher than anticipated based on existing evidence. Cognitive social capital was found to be negatively associated with chronic PTSD, while no significant association was found for structural social capital. Specifically, those with high cognitive social capital had an almost two times lower prevalence of chronic PTSD (PR = 1.83, 95% CI: 1.50, 2.22) compared with those with low cognitive social capital. No independent association between structural social capital and chronic PTSD was found (PR = 1.44, 95% CI: 0.70, 2.97). In conclusion, cognitive social capital, but not structural social capital, has a protective influence on the occurrence of chronic PTSD in survivors of natural disasters. These results may have public health implications. For example, pre- and post-disaster community-based interventions that catalyze and foster dimensions of cognitive social capital may aid in ameliorating the effect of earthquakes and other natural disasters on populations with high vulnerability to such events and poor access to mental health and other support services.
The frequency of traumatic events and comorbid post-traumatic stress disorder (PTSD) in women with eating disorders (ED) was assessed. Also, patients with anorexia nervosa (AN) and bulimia nervosa (BN) were compared; post-traumatic symptomatology and the role of psychosocial resources were analyzed. One hundred three ED patients (29.1±10.5 years) were studied through the use of standardized questionnaires. We found that 23.1% of AN and 25.5% of BN patients fulfilled the study definition for a current diagnosis of PTSD. Cumulative traumatization led to more severe symptomatology. Psychosocial resources were found to have strong associations with symptomatology. These findings provide additional support for the association between traumatization and ED. Clinical interventions for traumatized ED patients may benefit from a focus on post-traumatic stress symptomatology and personal resources.
Individuals with posttraumatic stress disorder (PTSD) are more likely to undertake harmful health behaviors like substance use. Less is known about the association of PTSD with healthful behaviors such as healthy diet and exercise. The purpose of this study was to examine differences across physical health indicators and health behaviors in individuals with and without PTSD.
A cross-sectional, case--control study of health indicators and self-reported health behaviors in a community and military veteran sample was used.
Based on a structured psychiatric interview, 25 participants had PTSD, and the remaining 55 without PTSD served as the comparison group. Participants were 40 years old on average and 45% were female. Multivariate analysis of variance analyses revealed that participants with PTSD had significantly higher body mass index (p = 0.004), had more alcohol use (p = 0.007), and reported fewer minutes of vigorous exercise (p = 0.020) than those without PTSD. Chi-square analysis of diet content and eating behavior constructs found that individuals with PTSD ate fewer fruits (p = 0.035) and had more guilt after overeating (p = 0.006).
These findings replicate prior research on the link between PTSD and negative health outcomes and engagement in harmful health behaviors and highlight the need for further examination of the association between PTSD and other health behaviors like diet content, eating behaviors, and exercise.
Background:
Post-traumatic stress disorder (PTSD) represents one of the most frequently psychiatric sequelae to earthquake exposure. Increasing evidence suggests the onset of maladaptive behaviors among veterans and adolescents with PTSD, with specific gender differences emerging in the latter. Aims of the present study were to investigate the relationships between maladaptive behaviors and PTSD in earthquake survivors, besides the gender differences in the type and prevalence of maladaptive behaviors and their association with PTSD.
Methods:
900 residents of the town of L'Aquila who experienced the earthquake of April 6th 2009 (Richter Magnitude 6.3) were assessed by means of the Trauma and Loss Spectrum-Self Report (TALS-SR).
Results:
Significantly higher maladaptive behavior prevalence rates were found among subjects with PTSD. A statistically significant association was found between male gender and the presence of at least one maladaptive behavior among PTSD survivors. Further, among survivors with PTSD significant correlations emerged between maladaptive coping and symptoms of re-experiencing, avoidance and numbing, and arousal in women, while only between maladaptive coping and avoidance and numbing in men.
Conclusions:
Our results show high rates of maladaptive behaviors among earthquake survivors with PTSD suggesting a greater severity among men. Interestingly, post-traumatic stress symptomatology appears to be a better correlate of these behaviors among women than among men, suggesting the need for further studies based on a gender approach.
Background:
Body image is a multidimensional construct with cognitive-affective, behavioral and perceptive components. Survivors of childhood sexual abuse report a disturbance of the cognitive-affective component of their body image but not of the perceptive component. It has not yet been examined whether and how the behavioral component is affected. Also, it is still unknown whether the disturbances might be due to the influence of co-occurring eating disorders.
Sampling and methods:
The cognitive-affective and behavioral components of the body image of 84 female participants with posttraumatic stress disorder (PTSD) after childhood sexual abuse (31 with a co-occurring eating disorder) and 53 healthy participants were assessed via the Dresden Body Image Inventory (Dresdner Körperbildfragebogen-35, DKB-35) and the Body Image Avoidance Questionnaire (BIAQ).
Results:
PTSD patients reported significantly higher negative scores on all DKB-35 subscales (p < 0.001) and the BIAQ (p = 0.002; p < 0.001). Results remained consistent after accounting for the influence of co-occurring eating disorders (p = 0.021; p = 0.001; p < 0.001).
Conclusions:
Results show for the first time that the behavioral component of the body image is impaired in female patients with PTSD in addition to the cognitive-affective component. This is not solely due to a comorbid eating disorder. The effect of established treatments on the body image of PTSD patients should be evaluated and new treatment modules should be developed and tested, if necessary.
Studies of specific groups such as military veterans have found that posttraumatic stress disorder (PTSD) is linked to adverse health outcomes including unhealthy weight. The aim of this study was to examine the relationship between PTSD symptoms, experiences of childhood trauma and weight in a community sample.
A stratified random probability survey was conducted in Denmark by the Danish National Centre for Social Research between 2008 and 2009 with 2,981 participants born in 1984, achieving a response rate of 67%. The participants were interviewed with a structured interview with questions pertaining PTSD symptomatology, exposure to childhood abuse, exposure to potentially traumatizing events, height, and weight. Underweight was defined by a body mass index (BMI) <18.5, overweight was defined by a BMI ≥25 and <30 and obesity was defined by a BMI ≥30.
PTSD symptomatology and childhood abuse were significantly associated with both underweight and overweight/obesity. Childhood emotional abuse was especially associated with underweight, whereas sexual abuse and overall abuse were particularly associated with overweight/obesity.
These findings indicate that health care professionals may benefit from assessing PTSD and childhood abuse in the treatment of both overweight and underweight individuals.
Cortisol secretions serve as the barometer of the hypothalamic-pituitary-adrenal (HPA) axis, which regulates and controls responses to stress. Studies of cortisol secretions in patients with posttraumatic stress disorder (PTSD) reveal inconsistent results.
Current research on HPA axis functioning in PTSD is examined to elucidate the neuroendocrine contributions in the disorder, identify current treatment's impact on the HPA axis, and consider implications for nursing care and areas for future research.
There is evidence for HPA dysregulation in PTSD, which contributes to widespread impairment in functions such as memory and stress reactivity and to physical morbidity via processes such as allostatic load. There is limited, but building, evidence that dehydroepiandrosterone (DHEA), which is released simultaneously with cortisol, may provide anti-glucocorticoid and neuroprotective effects.
Current treatments such as selective serotonin reuptake inhibitors and psychotherapy may have a beneficial impact on the HPA axis in PTSD populations. Somatic approaches to treating PTSD have not yet been studied in relation to their impact on HPA axis parameters in PTSD patients. Treatment studies of DHEA or glucocorticoids have not yet used HPA axis endpoints. PTSD treatment studies that include measures of HPA axis target mechanisms and consider HPA axis regulation as an additional treatment outcome are warranted.
This study examines the association of posttraumatic stress disorder (PTSD) symptoms with fast food and soda consumption, unhealthy dieting behaviors, and body mass index (BMI) in a group of young women.
This study was conducted on cross-sectional data gathered from 3181 females 16-24 years of age attending five publicly funded clinics in Texas. The associations among PTSD, fast food consumption frequency, soda consumption frequency, unhealthy dieting behaviors, and BMI were examined using binary and ordinal logistic regression.
PTSD symptoms were associated with an increased frequency of consumption of fast food and soda as well as unhealthy dieting behaviors but not with increased body mass index (BMI).
PTSD symptoms adversely affect both eating and dieting behaviors of young women. These behaviors may have negative long-term consequences for the health of females with PTSD symptoms.
Few prospective data exist on the risk of diabetes in individuals serving in the U.S. military. The objectives of this study were to determine whether military deployment, combat exposures, and mental health conditions were related to the risk of newly reported diabetes over 3 years.
Data were from Millennium Cohort Study participants who completed baseline (July 2001-June 2003) and follow-up (June 2004-February 2006) questionnaires (follow-up response rate = 71.4%). After exclusion criteria were applied, adjusted analyses included 44,754 participants (median age 36 years, range 18-68 years). Survey instruments collected demographics, height, weight, lifestyle, military service, clinician-diagnosed diabetes, and other physical and mental health conditions. Deployment was defined by U.S. Department of Defense databases, and combat exposure was assessed by self-report at follow-up. Odds of newly reported diabetes were estimated using logistic regression analysis.
Occurrence of diabetes during follow-up was 3 per 1,000 person-years. Individuals reporting diabetes at follow-up were significantly older, had greater baseline BMI, and were less likely to be Caucasian. After adjustment for age, sex, BMI, education, race/ethnicity, military service characteristics, and mental health conditions, only baseline posttraumatic stress disorder (PTSD) was significantly associated with risk of diabetes (odds ratio 2.07 [95% CI 1.31-3.29]). Deployments since September 2001 were not significantly related to higher diabetes risk, with or without combat exposure.
In this military cohort, PTSD symptoms at baseline but not other mental health symptoms or military deployment experience were significantly associated with future risk of self-reported diabetes.
Posttraumatic stress disorder (PTSD) is a significant risk factor for cardiovascular and metabolic disease.
The purpose of the current review is to evaluate the evidence suggesting that PTSD increases cardiovascular and metabolic risk factors, and to identify possible biomarkers and psychosocial characteristics and behavioral variables that are associated with these outcomes.
A systematic literature search in the period of 2002-2009 for PTSD, cardiovascular disease, and metabolic disease was conducted.
The literature search yielded 78 studies on PTSD and cardiovascular/metabolic disease and biomarkers.
Although the available literature suggests an association of PTSD with cardiovascular disease and biomarkers, further research must consider potential confounds, incorporate longitudinal designs, and conduct careful PTSD assessments in diverse samples to address gaps in the research literature. Research on metabolic disease and biomarkers suggests an association with PTSD, but has not progressed as far as the cardiovascular research.
This study investigated the symptoms of Posttraumatic Stress Disorder (PTSD) and associated risk factors among adult survivors 2 mo. after the Wenchuan earthquake in China. 228 survivors completed the Chinese version of the Impact of Event Scale-Revised. The prevalence of probable PTSD was 43%. The significant predictive factors for the severity of PTSD symptoms included being female, having lower educational level, being bereaved, and witnessing death. Findings of this study suggest that PTSD is a common mental health problem among earthquake survivors in China. Given inadequate knowledge and practices concerning the mental health of disaster victims in China, the information provided by this study is useful for directing, strengthening, and evaluating disaster-related mental health needs and interventions after earthquakes.
This study sought to determine if rates of childhood sexual, physical, psychological, and multiple abuse (i.e., abuse in more than one form) differed between women with a lifetime history of bulimia nervosa and women with no history of eating disorders.
Subjects were 80 women, aged 18-35, with a lifetime history of bulimia nervosa (40 women who had recovered for a year or more and 40 women currently suffering from bulimia nervosa) and 40 women who had never had an eating disorder or related difficulties. The cohort was obtained primarily by newspaper advertisement. Subjects participated in structured diagnostic interviews and completed paper-and-pencil questionnaires related to abusive experiences in childhood.
Women in the bulimia nervosa group reported higher levels of childhood physical, psychological, and multiple abuse. Contrary to expectation, rates of sexual abuse did not distinguish the groups, except in combination with other forms of abuse.
The higher rates of psychological, physical, and multiple abuse found among women with a lifetime history of bulimia nervosa than among comparison subjects underscore the importance of examining the full range of possible abusive experiences in women with eating disorders, rather than focusing simply on sexual abuse.
Objective
In recent years there has been increased interest regarding the role of crime victimization in the development and/or maintenance of eating disorders, particularly bulimia nervosa. Method: To examine the relationship among assault, bulimia nervosa, and binge eating disorder, a national, representative sample of 3,006 women completed structured telephone interviews. Results: Lifetime prevalence of completed, forcible rape for respondents with bulimia nervosa was 26.6%, as compared with 11.5% for respondents with binge eating disorder and 13.3% for respondents without bulimia nervosa or binge eating disorder. Compared to respondents without bulimia nervosa or binge eating disorder, aggravated assault history was significantly more prevalent in women with bulimia nervosa (26.8%), as was a lifetime history of posttraumatic stress disorder (36.9%). Characteristics of sexual assault experiences were not associated with dysfunctional eating patterns. Specific types of disordered eating such as compensatory behaviors in bulimia nervosa were associated with higher rates of victimization. Conclusions: In sum, the significantly higher rates of both sexual and aggravated assault among women with bulimia nervosa compared with women without such a diagnosis support the hypothesis that victimization may contribute to the development and/or maintenance of bulimia nervosa. © 1997 by John Wiley & Sons, Inc. Int J Eat Disord 21: 213–228, 1997.
Citation: Pagoto SL. (ed.) (2011). Psychological Co-Morbidities of Physical Illness: A Behavioral Medicine Perspective. Springer. ISBN 978-1-4419-0030-2 (Print) 978-1-4419-0029-6 (Online). DOI 10.1007/978-1-4419-0029-6.
Book preview also available via Google Books.
Summary: Evidence for the efficacy of behavioral approaches to the treatment and management of physical illness is mounting, as is the evidence for behavioral interventions for psychological disorders. A pressing question that remains is how to effectively treat co-morbid physical and psychological illnesses. Diseases co-occur more often than not, and the co-occurrence of physical and psychological illnesses is associated with greater impairment and healthcare costs. Unfortunately, the treatment literature has traditionally been disease-specific, with fewer insights and discoveries regarding the underlying processes of co-morbid physical and psychological illnesses, and even fewer of approaches to treatment.Research on co-morbidities between physical and psychological illnesses has focused primarily on depression. Quite extensive literatures describe the negative impact of depression on type 2 diabetes, cardiovascular disease, cancer, obesity, pain, and other physical illnesses. More recently, higher rates of physical illness have been documented in individuals with bipolar disorder, anxiety disorders, schizophrenia, and impulse control disorders. Studies emanating from the National Comorbidity Survey-Replication (NCS-R), the only U.S. population-based database that includes diagnostic information on all DSM-IV psychological disorders, have revealed strong links between a number of physical and psychological illnesses. These data draw attention to the prevalence of physical and psychological co-morbidities at the population level, which has stimulated research on the biobehavioral mechanisms of those co-morbidities, with the goal of developing and improving treatment approaches. As this area of research grows, practical resources are needed for clinicians and researchers who encounter individuals with co-morbid physical and psychological illnesses in their work. This book is the first to provide a comprehensive overview of psychological co-morbidities of physical illness, biological and behavioral mechanisms of those co-morbidities, and implications for treatment. Each chapter focuses on a physical condition, such as obesity, type 2 diabetes, HIV infection, tobacco dependence, cardiovascular disease, cancer, asthma, pain, irritable bowel syndrome, autoimmune disorders, and obstetric/gynecological conditions. Chapters are structured to cover 1) the epidemiology of the most prevalent co-morbid psychological disorders within that physical condition (e.g., depression and other mood disorders, anxiety disorders, psychotic disorders, impulse control disorders, and eating disorders; 2) biobehavioral mechanisms of the co-morbidity; 3) a review of the behavioral treatment literature including evidence-based practice guidelines (where available); and 4) treatment considerations including issues of stepped care, evidence-based treatment decisions, treatment sequencing, treatment blending, treatment interactions, and contraindications. Content is guided by available research evidence and relevant theoretical models, and it is presented in such a way as to inform clinical practice, identify important gaps in the research literature, and provide directions for future research. The book serves as a tool for clinicians and researchers who work in the area of behavioral medicine in medical, academic, and/or training settings. Patients with psychological and medical co-morbidities may be encountered by clinicians working in either mental health or medical settings, where the presenting problem could be either the psychological disorder or the medical disorder. As such, assessment and treatment issues are discussed from both perspectives. For the clinician, the book reviews brief assessment tools, provides practical summaries of the treatment outcome literature and treatment considerations (e.g., treatment sequencing, contraindications), and includes treatment decision hierarchies that help the clinician incorporate each facet of evidence-based decisions (the evidence, patient characteristics, and their own expertise). For the researcher, the book brings together the literature for the medical and psychological disorder, highlighting still unanswered research questions relevant to the co-morbidity. Literature relevant to the underlying biobehavioral mechanisms of the co-morbidity as well as treatment are summarized. While a vast literature exists for the treatment of these disorders in isolation, one important purpose of this book is to bring together this literature to uncover specific areas in need of future study that will further our understanding of why different disorders co-occur and the best ways to treat them when they do.
Epidemiological studies have examined the relative importance of Traumatic Events (TEs) in accounting for the societal burden of post-traumatic stress disorder (PTSD). However, most studies used the worst trauma experienced, which can lead to an overestimation of the conditional risk of PTSD. Although a number of epidemiological surveys on PTSD have been carried out in the United States, only a few studies in limited sample have been conducted in Italy. This study, carried out in the framework of the World Mental Health Survey Initiative, is a cross-sectional household survey of a representative sample of the Italian adult population. Lifetime prevalence of TEs and 12-month prevalence of PTSD were evaluated using the Composite International Diagnostic Interview (CIDI). Reports of PTSD associated with randomly selected TEs were weighted by the individual-level probabilities of TE selection to generate estimates of population-level PTSD risk associated with each TE. Network events was the most commonly reported class of TEs (29.4%). War events had the highest conditional risk of PTSD (12.2%). The TEs that contributed most to societal PTSD burden were unexpected death of a loved one (24.1%) and having seen atrocities (18.2%). Being female was related to high risk of PTSD after experiencing a TE. Exposure to network events is commonly reported among Italian adults, but two TEs are responsible for the highest burden associated with PTSD: the unexpected death of someone close and sexual assault. These results can help designing public health interventions to reduce the societal PTSD burden.
Bipolar patients seem to be at high risk of trauma exposure and, when exposed, of PTSD. When comorbid, PTSD has shown a negative impact on the course of the bipolar illness. Conversely, a correlation between even manic symptoms and an increased risk for suicide has also been reported in PTSD patients. The aim of this study was to investigate the relationships between lifetime mood spectrum symptoms and PTSD in a sample of earthquake survivors.
A total of 475 young adults who survived the L'Aquila 2009 earthquake, 21months earlier, were assessed by the Moods Spectrum-Self Report (MOODS-SR) and the Trauma and Loss Spectrum Self Report (TALS-SR).
Significantly higher MOODS-SR and TALS-SR domain scores were found in PTSD survivors compared to those without. The mood depressive (O.R.=1.17, 95% CI: 1.10-1.25), cognition depressive (O.R.=1.07, 95% CI: 1.01-1.14) and energy manic (O.R.=1.13, 95% CI: 1.02-1.25) MOODS-SR domains were significantly associated with an increased likelihood of PTSD.
Our data corroborate the strong relationship between mood disorder and PTSD highlighting a relationship between lifetime depressive and manic symptoms and PTSD, with a particular impact of the latter on the number of traumatic exposures and maladaptive behaviors.
PTSD is one of the most frequently occurring sequelae in earthquake survivors and increasing literature has been focused on its potential risk factors. More recently increasing evidence has highlighted the onset of maladaptive behaviours in the same populations. The aim of the present study was to explore: 1) the role of degree of exposure ("direct" vs "indirect"), gender and age (> o ≤40) as potential risk factors for PTSD in a sample of L'Aquila 2009 earthquake survivors; 2) the role of these same variables and of PTSD as potential risk factors for maladaptive behaviours in the same sample. A group of 444 subjects was evaluated by the Trauma and Loss-Self Report (TALS-SR) 10 months after exposure. Results showed significantly higher PTSD prevalence rates in: exposed with respect to not exposed subjects; women with respect to men (in the whole sample and in all subgroups, with the only exception of the older subjects not exposed); not exposed younger women with respect to the older ones. PTSD and "direct" exposure represented a major risk factor for the presence of at least one maladaptive behaviour, with female gender playing a role only among no-PTSD subjects. For the TALS-SR item n.99 ("Use alcohol or drugs or over-the-counter medications to calm yourself...?") only PTSD and "direct" exposure emerged as risk factors. Our results confirm the pervasive effects of earthquakes for mental health in the general population, and highlight the role of gender and proximity as primary correlates of PTSD, and of PTSD and degree of exposure for maladaptive behaviours, particularly alcohol and substance use.
The present study investigated the relationship between posttraumatic stress disorder (PTSD) and emotional eating in a sample of medically healthy and medication-free adults. Participants with PTSD (n = 44) and control participants free of lifetime psychiatric history (n = 49) completed a measure of emotional eating. Emotional eating is the tendency to eat or overeat in response to negative emotions. PTSD participants exhibited greater emotional eating than control participants (η(2) = .20) and emotional eating increased with higher PTSD symptom severity (R(2) = .11). Results supported the stress-eating-obesity model whereby emotional eating is a maladaptive response to stressors. Over time, this could lead to weight gain, particularly abdominal stores, and contribute to higher risk for comorbid medical disorders. Findings suggest the importance of future longitudinal research to understand whether emotional eating contributes to the high rates of obesity, diabetes, and heart disease in PTSD.